Effect of Nursing Care Delivery Models on Registered Nurse Outcomes

The two key components of models of nursing care delivery are mode of nursing care delivery and skill mix. While mode of nursing care delivery refers to the independent or collaborative work of nurses to provide care to a group of patients, skill mix is defined as direct care nurse classifications. Previous research has typically focused on only one component at a time (mode or skill mix). There exists little research that investigates both components simultaneously. This study examined the effect of mode of nursing care delivery and skill mix on nurse emotional exhaustion and job satisfaction after controlling for nurse demographics, workload factors, and work environment factors. A secondary analysis was done with survey data from 416 British Columbia medical–surgical registered nurses. Data were analyzed using hierarchical multiple regression and moderated regression. Registered nurses in a skill mix with licensed practical nurses reported lower emotional exhaustion when caring for more acute patients compared with those in a skill mix without licensed practical nurses. While mode of nursing care delivery was not related to nurse outcomes, work environment factors were the strongest predictors of both nurse outcomes. Skill mix moderated the relationship between patient acuity and emotional exhaustion. Nurse managers should invest in nurses’ conditions of work environments.